• Document No.

  • Conducted on

  • Prepared by

Owner or Tenant Details

  • Owner or Tenant Name

  • Addresss
  • Officer Name

  • I have been advised by the above mention Officer of the following:
    1. of the purpose of entering the property;
    2. that anything or information found on the property may be used as evidence in court;
    3. agreement to entry was voluntarily given by me; and
    4. I was not obliged to give permission to enter the property.

    I agree to the entry for the purpose of exercising powers under Chapter 5 of the Local Government Act 2009.

    I have received a copy of this document.

  • Occupier's Signature

  • Authorised Person's Signature

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